Provider Demographics
NPI:1487896676
Name:PERSONAL HEARING SOLUTIONS
Entity type:Organization
Organization Name:PERSONAL HEARING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / HEARING AID SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:HEARING AID SPECIALI
Authorized Official - Phone:321-253-6310
Mailing Address - Street 1:8085 SPYGLASS HILL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7984
Mailing Address - Country:US
Mailing Address - Phone:321-253-6310
Mailing Address - Fax:321-751-6798
Practice Address - Street 1:8085 SPYGLASS HILL RD STE 107
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-7984
Practice Address - Country:US
Practice Address - Phone:321-253-6310
Practice Address - Fax:321-751-6798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2747332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherBLUE CROSS BLUE SHIELD